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Sequestration takes a toll on cancer patients, Medicare

04/05/13 11:11 AMUpdated 10/07/13 06:18 PM

Sequestration takes a toll on cancer patients, Medicare

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A funny thing happened on Rush Limbaugh’s radio show yesterday. The Republican host was complaining about a Washington Post report on sequestration cuts hurting cancer patients in the Medicare program, and told his listeners to ignore the news. “All of this is manufactured and made up,” Limbaugh said. How does he know? Because the sequester didn’t include “any cuts in Medicare,” he added.

And then Limbaugh got a call from a conservative oncologist – in this case, a physician who apparently shares the host’s worldview and has no use for the Washington Post – who conceded that the report is, in fact, accurate, forcing Limbaugh to change the subject.

Sequestration cuts are affecting Medicare – though not as much as some other programs – and as Sarah Kliff explained, cancer clinics really are turning away thousands of patients as a result of the Republican spending cuts.

Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

Kliff talked to one Long Island oncologist who said he and his staff held an emergency meeting earlier this week and decided they would no longer see one-third of their 16,000 Medicare patients. “It’s a choice between seeing these patients and staying in business,” Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates said.

But if Medicare was supposed to be shielded from the sequestration policy, how is this happening? It has to do with how medical offices are reimbursed for medications that need to be administered by a physician – such as those given to cancer patients.

The so-called sequester cuts will force three-quarters of the thousands of cancer clinics nationwide to start referring Medicare patients to hospitals, according to the American Society of Clinical Oncology and other cancer treatment groups, which have appealed to the White House and Congress for help.

Elderly cancer patients are being hit hard because their drugs are among the handful of pharmaceuticals that were affected by the sequester cuts.

Medicare reimbursed oncologists for the cost of chemo drugs, plus 6%. But under the sequester, the federal government is now providing only 4% on top of the drugs’ cost, which can run $900 to $15,000 for a full course, depending on the cancer.

That 2% difference may not sound like much, but given the costs involved, it’s an enormous pay cut for the cancer clinics, which some are now saying is a prohibitive new expense they can’t afford.

Ted Okon, director of the Community Oncology Alliance, told Kliff, “If you get cut on the service side, you can either absorb it or make do with fewer nurses. This is a drug that we’re purchasing. The costs don’t change and you can’t do without it. There isn’t really wiggle room.”

Note, this doesn’t mean the sequester is necessarily cutting off cancer patients, but rather, it means these patients are being told by their local oncology clinics that they’ll have to seek care at hospitals – where the care will be less efficient and more expensive.

In case anyone’s forgotten, it’s within Congress’ power to simply turn the sequester off. The whole thing could take five minutes. But for now, congressional Republicans have ruled out the possibility of turning it off, and have also ruled out the possibility of a compromise to replace these brutal spending cuts.

With each passing day, we learn of increasingly drastic consequences associated with the policy.